title: Comparison of intravascular ultrasound to contrast-enhanced 64-slice computed tomography to assess the significance of angiographically ambiguous coronary narrowings.
abstract: The efficacy of contrast-enhanced multislice computed tomography (MSCT) for assessment of ambiguous lesions is unknown. We compared both quantitative coronary angiography (QCA) and MSCT to the gold standard for a significant stenosis-minimum luminal area (MLA) by intravascular ultrasound (IVUS)-in 51 patients (64 +/- 10 years old, 19 men) with 69 angiographically ambiguous, nonleft main lesions. The MSCT was performed 17 +/- 18 days before IVUS analysis. Overall diameter stenosis by QCAwas 51.0 +/- 9.8%; 39 of 51 patients (76%) eventually underwent revascularization (38 by percutaneous coronary intervention and 1 by coronary artery bypass graft). By univariate analysis, minimum luminal diameter, MLA, lumen visibility by MSCT, and minimum luminal diameter by QCA were significant predictors of MLA by IVUS <or=4.0 mm(2). In mildly calcified lesions (calcium burden by MSCT <or=1), MLA by MSCT was a much better predictor than in more calcified lesions. By multivariate logistic regression analysis, only MLA by MSCT (odds ratio 0.754, 95% confidence interval 0.571 to 0.995, p = 0.0458) was predictive of MLA by IVUS <or=4.0 mm(2). In conclusion, in angiographically ambiguous lesions in which QCA does not distinguish significantly from nonsignificant stenosis, MSCT-measured MLA can predict significant stenosis with MLA <or=4.0 mm(2) measured by IVUS.
authors.affiliation: Cardiovascular Research Institute, Washington Hospital Center, Washington, DC, USA.
authors.forename: Teruo
authors.initials: T
authors.lastname: Okabe
authors.forename: Wm Guy
authors.initials: WG
authors.lastname: Weigold
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Robert
authors.initials: R
authors.lastname: Roswell
authors.forename: Subodh
authors.initials: S
authors.lastname: Joshi
authors.forename: Sung Yun
authors.initials: SY
authors.lastname: Lee
authors.forename: Bongryeol
authors.initials: B
authors.lastname: Lee
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.forename: Probal
authors.initials: P
authors.lastname: Roy
authors.forename: Tina L Pinto
authors.initials: TL
authors.lastname: Slottow
authors.forename: Kimberly
authors.initials: K
authors.lastname: Smith
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007479:Iopamidol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D003287:Contrast Media; D007479:Iopamidol